This review assessed a clearly defined research question using a broad range of study types. A number of databases were searched for relevant studies. Although no language restrictions were applied, two studies were excluded as no English translations were available, so the review was at risk of language bias. The risk of publication bias was unclear, but all of the included studies appeared to be published; little attempt to locate unpublished studies was apparent. The risk of reviewer error and bias was also unclear, as the review methods for the extraction of study data and the number of reviewers involved in assessing the quality of the studies were not reported .
The clinical differences between the included studies precluded meta-analysis, particularly the variability in diagnosis, health-related quality of life instruments, and timings of assessment. A narrative synthesis appeared appropriate, but the apparent risk of bias within some of the non-randomised studies suggested that the data may not be reliable. The authors recommended further good quality research should be carried out to confirm the review findings.
The authors' conclusions appear appropriately cautious, but their reliability is potentially compromised by methodological weaknesses in certain studies, the lack of detail for some review methods, and the risk of missing data.
Two authors acknowledged financial support from Ethicon Endo-surgery (manufacturers of laparoscopic surgical instruments) and/or Karl Storz (endoscope manufacturers).